Homestead_Wilkinson tea, CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
° _it, 4 STANDARD/SUPPLEMENTAL DEDUCTION FORM
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i % State Form 5473(R18/1-20) HC10 7/)�f a�
e D 1 Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) ..� PO 11 15o4 certify that I(we)occupied as my(our)principal
place of residen. a ( re)buying the fo lowing described real property under contract for which a Homestead Property Tax Standard
Deduction is her- claimed on the date this application is signed, (date of signature). I(We):
Own. ❑ Am(are)buying under recorded contract.
❑ m (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ ave a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
Social Security number of claimant's spouse(last live digits) Driver's license/Identification I Other number of claimant's spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number.)
' h Y 5� ate.
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name i ! 7 i
Recorder's office where contract is recorded S E 11-ecg•L/!rdpYoUUiY1u1 D20 Page
PROPERTY DESCRIPTION UU
County q Township Taxing district(city,town,townshi,•
J`\ Q VI • °° (R�
9 descriptionI the ropelr{�yi`nS-g9e COUNTY AUDITOR
Parcel number Legal
Real property 0 Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrou s t t structure is used to produce income,describe the use and portion
of the property utilized to produce income.
a(() ___ D\ 10_- s_ zoo _000 ,1164 ,---ool..
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Yes ❑ No `1 i )S k
A
Sign re of claimant/
I hereby certify the above statements are true,correct,and complete. f P i
Address of contact(number and street,city,state,and ZIP code) ddress of va atell hom-ste.,•,I any(numbera sire t city,`/t,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3) H 4 g LI 2t., e was
Residential improvements or Dwelling (4) ` 7 a ',, U19-61 '
annually assessed mobile/ t•f V--3 �
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lease • 60%. the assessed value of the homestead or$45,000.
Notwithstanding any other provisio • .f the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real propert • . - anufactured home that i essed as real property may
not exceed one-half(1/2)of the ass. alue of th- .bile ho or manufac red home.
Signature of Auditor I `\ l , Date signed onth,day, .
4• 'W\
DISTRIBUTION: Original-County Auditor,' -Stamped Copy-Taxpayer
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